["Super-extensive lymph node dissection" for advanced gastric cancer]

Our "super-extensive lymph node dissection" (SELD) for gastric cancer is designed to remove the nodes as thoroughly as possible from the n4-area, i.e., para-aortic area from diaphragmatic crus to IMA, and para-superior mesenteric trunk. One hundred and sixty three cases of gastric cancer, treated with SELD is reviewed. 1) ps (+) cases had n4 metastasis in 25.8%, incidence being compatible to n1 or n2 cases. 2) Prognosis was relatively good in the cases whose cancer positive rate of the dissected n4 lymph nodes was found below 25%. 3) Recurrence was noted in the remaining lymph nodes in the cases, whose rate of lymph node metastasis had been high in preceding surgery. This fact seems to warrant SELD for advanced gastric cancer. 4) SELD however, was accompanied by the longer duration of surgery with more blood loss and by higher incidence of complications, than conventional R2, R3 dissection.